Understanding Rotator Cuff Tears: Insights for Detection and Treatment
Rotator cuff tears are a prevalent shoulder pathology that can lead to significant pain and disability. These tears can be either symptomatic, causing noticeable pain and dysfunction, or asymptomatic, where they go unnoticed by the individual. Understanding the prevalence of both types is crucial for healthcare providers to ensure early detection and effective treatment, ultimately improving patient outcomes.
General Prevalence and Age Correlation
One of the most striking aspects of rotator cuff tears is how their prevalence increases with age. Research has shown that the incidence of rotator cuff tears in the general population ranges from 20.7% to 30.24% (1-2). As people age, particularly those over 50, the likelihood of developing a rotator cuff tear increases significantly. Studies indicate that 23% to 51% of individuals in this age group may have an asymptomatic rotator cuff tear (3).
This correlation between age and prevalence highlights the importance of regular shoulder assessments for older adults, even in the absence of symptoms. Early detection of asymptomatic tears can prevent progression to symptomatic tears, which are often more challenging to treat.
Symptoms of a Rotator Cuff Tear
There are a few hallmark signs of a rotator cuff tear(4):
1. Loss of ability to raise your arm overhead
2. Weakness of shoulder outward rotation
3. Pain extending from the shoulder down the outside of the arm
Symptomatic vs. Asymptomatic Tears
Interestingly, a large proportion of rotator cuff tears are asymptomatic. In fact, studies suggest that between 34.7% and 65.3% of detected tears do not cause any noticeable symptoms. However, this does not mean they are harmless (5). While people may not feel these asymptomatic tears, they may still affect shoulder function, be weaker than the other side, and may eventually become symptomatic if left untreated (6).
Individuals who have already experienced a rotator cuff tear in one shoulder are more likely to report symptoms in the contralateral shoulder. This suggests that prior injury may predispose patients to future tears, highlighting the need for ongoing monitoring and preventive care in these cases.
Risk Factors for Rotator Cuff Tears
Several risk factors contribute to the likelihood of developing a rotator cuff tear. These include age, as mentioned, older age is a significant risk factor, males more than females, a history of trauma, and previous shoulder injuries increase the risk (5,6). Dominant arm usage, tears are more common in the dominant arm, likely due to overuse. Individuals engaged in physically demanding jobs (particularly jobs involving repeated lifting and overhead work) are at higher risk. Lifestyle factors, smoking and diabetes have also been linked to a higher prevalence of rotator cuff tears.
Understanding these risk factors allows healthcare providers to identify individuals who may benefit from preventive measures or early intervention.
Impact on Function and Healthcare
Even in cases where rotator cuff tears are asymptomatic, they can still lead to decreased shoulder function. This can affect a person’s quality of life, limiting their ability to perform daily activities and, in some cases, leading to chronic pain or further injury.
Patients with rotator cuff tears, whether symptomatic or not, often show lower scores in shoulder function assessments such as range of motion screening, strength tests and functional movement screens. As a result, these individuals are more likely to seek medical attention, leading to increased healthcare utilization.
Conclusion
Rotator cuff tears are a common condition, particularly in older adults, with many cases remaining asymptomatic. The prevalence of these tears increases with age and is influenced by factors such as gender, trauma history, and lifestyle. Despite many tears being asymptomatic, they can still impact shoulder function and lead to increased healthcare utilization.
By focusing on prevention and early treatment, physiotherapists and other healthcare professionals can significantly improve outcomes for patients with rotator cuff tears. Your physiotherapist or chiropractor will work with you to create a tailored strengthening and range of motion program.
REFERENCES
1. Reilly, P., Macleod, I., Macfarlane, R., Windley, J., & Emery, R. (2006). Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence.. Annals of the Royal College of Surgeons of England, 88 2, 116-21 . https://doi.org/10.1308/003588406X94968.
2. Yamamoto, A., Takagishi, K., Osawa, T., Yanagawa, T., Nakajima, D., Shitara, H., & Kobayashi, T. (2010). Prevalence and risk factors of a rotator cuff tear in the general population.. Journal of shoulder and elbow surgery, 19 1, 116-20 . https://doi.org/10.1016/j.jse.2009.04.006.
3. Tempelhof, S., Rupp, S., & Seil, R. (1999). Age-related prevalence of rotator cuff tears in asymptomatic shoulders.. Journal of shoulder and elbow surgery, 8 4, 296-9 . https://doi.org/10.1016/S1058-2746(99)90148-9.
4. Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87(7):1446-1455. doi:10.2106/JBJS.D.02335
5. Minagawa, H., Yamamoto, N., Abe, H., Fukuda, M., Seki, N., Kikuchi, K., Kijima, H., & Itoi, E. (2013). Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village.. Journal of orthopaedics, 10 1, 8-12 . https://doi.org/10.1016/j.jor.2013.01
6. Liem, D., Buschmann, V., Schmidt, C., Gosheger, G., Vogler, T., Schulte, T., & Balke, M. (2014). The Prevalence of Rotator Cuff Tears. The American Journal of Sports Medicine, 42, 826 - 830. https://doi.org/10.1177/0363546513519324.
